What is Keratoconus? | Your Questions Answered

What is Keratoconus? | Your Questions Answered


(light music) – A lot of people ask me,
What is keratoconus?” So, keratoconus is a distortion
of the very front surface of the eye, the cornea,
and it’s a weakness in the collagen; the cornea
is made up of these collagen links and these links break, and as they break, the
cornea comes out like the end of a rugby ball, so
it’s pointed like a cone. The majority of these
patients have some form of maybe allergies or hay fever and maybe a little bit of asthma and they get very itchy eyes,
and we’re not just talking a little rub, but actually
knuckle rubbing or palm grinding. And it’s that grinding that
helps break the collagen links and allows the cornea to become
steeper and also broader. So, you know it does run
in families with brothers, sisters, parents, and then
it can be in the family, but if you’re not a hay fever,
allergy sort of a person, you don’t get that rub,
and it doesn’t escalate. Keratoconus should not cause blindness. We can fit them up with a
contact lens of some description, and we can get them back to
fantastic quality of life: driving, holding down
a job, going to school, doing what they want to do. If it is not diagnosed, certainly glasses and soft contact lenses will
not correct their vision to a reasonable enough level that they can function normally. Blindness, no. If the keratoconus is significant enough that I can’t do something
for you with the correction and with a contact lens,
then there’s surgical options and then, you know, there’s a follow-up further down the track. But, yeah, I mean there’s
know reason for anyone to go blind from keratoconus. Can you cure keratoconus? The short answer is no. You can certainly improve the vision and the quality of life of the patients, whether it’s contact lenses. There are various techniques that some surgeons use by putting
little corneal inlays and rings in to try and flatten the cornea by pulling the cone back. But the majority of those
patients still will need a rigid lens or a soft lens to correct the residual prescription
or maybe even glasses. There are some patients who
I can’t do any more for, and then they’ll have
a corneal graft where the whole central portion of
the distortion is removed, and a donor cornea is sewn in. Fantastic results and very
amazing techniques now to what they used to do
20-odd years ago when I started practise, so the
outcomes are a lot better. There is still a significant
proportion of patients who have a graft, who will still
need a rigid contact lens. Okay, so don’t, I guess,
don’t get hopes up that having a corneal graft is
going to fix everything. There’s also a lot of medication that goes with a corneal graft, potential rejections, and
there is the life of the graft, so you know, you might find
yourself at 20 having a graft, and you might need to have it re-grafted in 20 or 30 years time,
so the longer you hang out and not have a graft, I think is a better prognosis long-term. Keratoconus does initially become worse and becomes steeper and
a little bit broader, and the majority of movement
of keratoconus is in the teens, so you know,
maybe 11 years old up to the early 20s, that sort of area. Like I mentioned earlier,
there’s that genetic component but if these kids are
really hopping in there, that’s where the problem arises. We do find that, you know, 20s, 30s, there is very good
stability of keratoconus, so it shouldn’t change, but
it all gets down to this. The more patients rub, all bets are off. It’s likely to become steeper and broader. You certainly can have keratoconus without actually realising it, so you can be measured
and have an astigmatism. The astigmatism can be
quite oblique and irregular, but if we can give you
good vision with glasses or soft contact lenses,
then yeah, you might have keratoconus but function quite normally. It’s when the keratoconus
becomes quite extreme and quite irregular, whether
it’s steep or broad in the shape of the cone, that
it really affects your vision. That’s where you outgrow
soft contact lenses and outgrow spectacles. Now when we talk about an asigmatism, an astigmatism, well the way I explain it to a patient is, you know,
if the front of your eye is round like a soccer ball, then we can easy enough to correct you whether you’re long-sighted or short-sighted. Then the shape of your eye could be like the side of a rugby
ball, so it can be long in one meridian and short in the other, and that is an astigmatism, so you can be long-sighted with an astigmatism, you can be short-sighted
with an astigmatism. And then there’s keratoconus,
and that’s where, you know, keratoconus has got this irregular
manifestation of astigmatism at a very irregular direction, but we can correct it
only to a certain extent, because of how irregular it is. So, it’s not, if you can imagine the side of a rugby ball or an egg, long end, short, this is
the end of a rugby ball, so it’s a pointy cone,
and it’s not working in two meridians, so an astigmatism means that your eye’s not
round like a soccer ball, it’s more football shape,
but in keratoconus, if it gets to a significant degree, then it’s more of a cone shape, and that’s where the two meridians of glasses and soft contact lenses just won’t correct and get you that quality of vision that we all desire. So normally, keratoconus is misdiagnosed as an astigmatism, and it certainly is a form of an astigmatism,
but it’s very variable and tends to change. So, patients come in and say, “Look, I got these glasses three or four weeks ago, six weeks ago, and it’s
really made no difference.” So, you get to a stage where you outgrow soft contact lenses and glasses. They just cannot correct,
because with glasses and soft contact lenses,
we can only correct in two planes, so one
short side and a long side, and the other plane for astigmatism. Whereas with this distortion, what we do with a rigid
lens is the tear layer overcomes this distortion,
which is between the back of the lens and the front of the eye. And then we’ve got a new
soccer ball front to the eye. So, vision’s blurred and, you know, traditionally, we just
can’t seem to fix it unless we diagnose it and go, “Wow, look at that.” So, for us, we put our patients on a corneal topographer,
and we’re going to map the curve on the front of the eye, and there is a definitive answer. Yes, you do, or no, you
don’t have keratoconus. Keratoconus can be like a prolapse, because instead of being like, you can imagine a soccer
ball, it’s now like the end of a rugby ball, you’ve got this pointy cone coming
forward, so yes, certainly. If I get a young keratoconic patient, and they’re 11 or 12, and glasses or soft contact lenses
are not going to help, then they need a rigid lens, and they’re probably progressing, I would send them straight off to a corneal ophthalmologist
for collagen cross-linking. And collagen cross-linking is trying to strengthen the cornea, so keratoconus is the break
in these collagen links, and the cone becoming steeper and broader, so it’s a very small procedure of using riboflavin, which
is like a vitamin B drop under a UV lamp for 30 minutes or so, trying to strengthen these bonds. In the majority of these
cases, it’s fantastic, stable, there’s no further development or change in that cornea,
but the same proviso, as long as you don’t rub, okay? So patients can have
collagen cross-linking, but if you rub, we’re
back to where we started, so that’s the hard thing. You’ve got allergies and itchy eyes, but you know, there are
also anti-allergy drops that we do use with our
patients to calm the eyes down. So, there’s lots of things that we can do. Most important thing
for keratoconus patients is please don’t rub your eyes. Types of contact lenses
available for keratoconus is, pick a brand or design. So there’s, you know,
we try and keep things as simple as we can for as long as we can, so if we can get a
patient with keratoconus across the line with
glasses, they’d stay there. If, you know, they want soft lenses, and we can give them good quality of life and vision with a soft lens,
we’ll go down that path. If we’re struggling with vision, our next position is it needs to be a rigid lens of some description. So, I guess the decision’s
sort of been taken away from us, and it’s no longer in our hands, well, all we can do is show the patient, well, this is the best I can get with a soft lens or glasses, but you know, if we can fit these lenses on you, we can get you down to, you know, what we would call, you
know, normal vision. And you know, for what I do, my main goal is just improving someone’s quality, doing what they want to do. If you want to go and be a painter or a sign writer or whatever, it’s just a matter of giving them that opportunity or the vision to do what they want to do. So, there’s rigid lenses,
we start in our practise, philosophy is the little corneal lenses, so it just sits within the coloured part of your eye there, we have the cornea sitting over the coloured
part of the pupil, the iris. So, we would go small initially, and the reason for that is
they’re a quicker turnaround, and they’re cheaper, and they
have a life of two years. If, for some reason,
we’re just not getting the vision or the comfort,
then we would offer them the next step up, which
is probably going to be either a hybrid lens or a scleral lens. They cost a lot more, their
life is a bit different. The hybrid is probably around 12 months, whereas the scleral’s still
going to be two years, but the cost is a lot more, and they take a little bit longer,
maybe 10 days to two weeks for them, you know, to arrive. When I sit down with a patient, just put all of the cards on the table, and say, look, this is where you are, this is what your topography, this is what the shape
of your eye looks like, and I can only do this. Anything less than that is, you know, a poor visual outcome. So there’s lots of variables. It really depends on the patient, and where they’ve been or you know, we do certainly have patients where we start with one type of lens, and that’s not for them, and we’ll, you know, morph onto a different one. We just do things very
differently to what, you know, a traditional
optometrist would do, and that’s what we do. It’s a lot of chair time, what we do. These patients need to come back. They pick up a pair of lenses, we need to see them in
a week to 10 ten days and find out what’s the
good, the bad, and the ugly, what’s, you know, irritating, gritty, or do we need to do
something about the vision. So, it’s a lot of chair time, but a lot of our patients
are in that situation where, I guess you could
say, they’re desperate. They need someone to
give them that next step; otherwise, I won’t drive,
I won’t have a job, and so it’s very
fulfilling, because I guess I don’t stand back often enough when, you know, patients come in and say, you know, I’ll have to retire, because without you, I
can’t do a, b, and c. So, yeah, you know, we’re a bit strange, because of what we do is a bit odd, but it’s a fantastic challenge, and you can make a great difference. So, I think the best
way, there’s two options, but I think the best way
to make an appointment to come in here is to, probably the best is to ring and chat to
Maureen on the phone or Dee about what you think you have or where you’ve been
and try and get a feel for what you need. You can certainly go online and fill out an online form and email
it in, and then we can get, you know, in contact with you and sort out an appointment time, try and work out, you know, what are your
needs and, you know, who do you need to see. So, all these links
that we’re talking about will be in the description below. So, if you like this
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